Comparisons in long-term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer

Pedro Ciudad, Oscar J. Manrique, Samyd S. Bustos, John J.P. Coca, Chang Cheng Chang, Pin Keng Shih, Fabio Nicoli, Federico L. Torto, Mouchammed Agko, Tony C.T. Huang, Michelle Maruccia, Hung Chi Chen

Research output: Contribution to journalArticle

Abstract

Background: Vascularized lymph node transfer (VLNT) is an emerging surgical treatment for lymphedema. However, literature-comparing outcomes of upper limb lymphedema (ULL) and lower limb lymphedema (LLL) is limited. Hence, the aim of this study is to compare the long-term clinical outcomes on ULL versus LLL in patients treated with VLNT. Methods: A retrospective study retrieving data from patients with International Society of Lymphology (ISL) stages II–III who underwent different VLNTs from July 2010 to July 2016 in our institution was performed. Demographics preoperatively, and clinical data (limb circumference, infectious episodes, lymphoscintigraphic studies) preoperatively and postoperatively were recorded. Clinical outcomes by extremity were also analyzed. Results: A total of 83 patients with lymphedema (ULL: n = 30, LLL: n = 53) were included. Mean follow-up time was 32.8 months (range 24–49 months). Mean circumference reduction was higher in patients with ULL compared to with LLL (28.6 ± 8.6 vs. 22.3 ± 10.1, p <.001), and for patients with secondary lymphedema (24.8 ± 9.6, p <.001) than for patients with primary lymphedema (18.9 ± 14, p >.05). Infectious episodes per year preoperative and postoperative showed that LLL patients had higher reduction on infection rate compared with ULL patients (2.4 ± 1.1 vs. 1.9 ± 1.2, p <.001). Conclusion: VLNT is a promising surgical treatment option for patients with lymphedema. This study suggests that VLNT may have a more beneficial outcome in patients with ULL and with secondary lymphedema.

Original languageEnglish (US)
JournalMicrosurgery
DOIs
StateAccepted/In press - Jan 1 2019

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Lymphedema
Lower Extremity
Lymph Nodes
Upper Extremity
Extremities

ASJC Scopus subject areas

  • Surgery

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Comparisons in long-term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer. / Ciudad, Pedro; Manrique, Oscar J.; Bustos, Samyd S.; Coca, John J.P.; Chang, Chang Cheng; Shih, Pin Keng; Nicoli, Fabio; Torto, Federico L.; Agko, Mouchammed; Huang, Tony C.T.; Maruccia, Michelle; Chen, Hung Chi.

In: Microsurgery, 01.01.2019.

Research output: Contribution to journalArticle

Ciudad, P, Manrique, OJ, Bustos, SS, Coca, JJP, Chang, CC, Shih, PK, Nicoli, F, Torto, FL, Agko, M, Huang, TCT, Maruccia, M & Chen, HC 2019, 'Comparisons in long-term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer', Microsurgery. https://doi.org/10.1002/micr.30508
Ciudad, Pedro ; Manrique, Oscar J. ; Bustos, Samyd S. ; Coca, John J.P. ; Chang, Chang Cheng ; Shih, Pin Keng ; Nicoli, Fabio ; Torto, Federico L. ; Agko, Mouchammed ; Huang, Tony C.T. ; Maruccia, Michelle ; Chen, Hung Chi. / Comparisons in long-term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer. In: Microsurgery. 2019.
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abstract = "Background: Vascularized lymph node transfer (VLNT) is an emerging surgical treatment for lymphedema. However, literature-comparing outcomes of upper limb lymphedema (ULL) and lower limb lymphedema (LLL) is limited. Hence, the aim of this study is to compare the long-term clinical outcomes on ULL versus LLL in patients treated with VLNT. Methods: A retrospective study retrieving data from patients with International Society of Lymphology (ISL) stages II–III who underwent different VLNTs from July 2010 to July 2016 in our institution was performed. Demographics preoperatively, and clinical data (limb circumference, infectious episodes, lymphoscintigraphic studies) preoperatively and postoperatively were recorded. Clinical outcomes by extremity were also analyzed. Results: A total of 83 patients with lymphedema (ULL: n = 30, LLL: n = 53) were included. Mean follow-up time was 32.8 months (range 24–49 months). Mean circumference reduction was higher in patients with ULL compared to with LLL (28.6 ± 8.6 vs. 22.3 ± 10.1, p <.001), and for patients with secondary lymphedema (24.8 ± 9.6, p <.001) than for patients with primary lymphedema (18.9 ± 14, p >.05). Infectious episodes per year preoperative and postoperative showed that LLL patients had higher reduction on infection rate compared with ULL patients (2.4 ± 1.1 vs. 1.9 ± 1.2, p <.001). Conclusion: VLNT is a promising surgical treatment option for patients with lymphedema. This study suggests that VLNT may have a more beneficial outcome in patients with ULL and with secondary lymphedema.",
author = "Pedro Ciudad and Manrique, {Oscar J.} and Bustos, {Samyd S.} and Coca, {John J.P.} and Chang, {Chang Cheng} and Shih, {Pin Keng} and Fabio Nicoli and Torto, {Federico L.} and Mouchammed Agko and Huang, {Tony C.T.} and Michelle Maruccia and Chen, {Hung Chi}",
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AU - Ciudad, Pedro

AU - Manrique, Oscar J.

AU - Bustos, Samyd S.

AU - Coca, John J.P.

AU - Chang, Chang Cheng

AU - Shih, Pin Keng

AU - Nicoli, Fabio

AU - Torto, Federico L.

AU - Agko, Mouchammed

AU - Huang, Tony C.T.

AU - Maruccia, Michelle

AU - Chen, Hung Chi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Vascularized lymph node transfer (VLNT) is an emerging surgical treatment for lymphedema. However, literature-comparing outcomes of upper limb lymphedema (ULL) and lower limb lymphedema (LLL) is limited. Hence, the aim of this study is to compare the long-term clinical outcomes on ULL versus LLL in patients treated with VLNT. Methods: A retrospective study retrieving data from patients with International Society of Lymphology (ISL) stages II–III who underwent different VLNTs from July 2010 to July 2016 in our institution was performed. Demographics preoperatively, and clinical data (limb circumference, infectious episodes, lymphoscintigraphic studies) preoperatively and postoperatively were recorded. Clinical outcomes by extremity were also analyzed. Results: A total of 83 patients with lymphedema (ULL: n = 30, LLL: n = 53) were included. Mean follow-up time was 32.8 months (range 24–49 months). Mean circumference reduction was higher in patients with ULL compared to with LLL (28.6 ± 8.6 vs. 22.3 ± 10.1, p <.001), and for patients with secondary lymphedema (24.8 ± 9.6, p <.001) than for patients with primary lymphedema (18.9 ± 14, p >.05). Infectious episodes per year preoperative and postoperative showed that LLL patients had higher reduction on infection rate compared with ULL patients (2.4 ± 1.1 vs. 1.9 ± 1.2, p <.001). Conclusion: VLNT is a promising surgical treatment option for patients with lymphedema. This study suggests that VLNT may have a more beneficial outcome in patients with ULL and with secondary lymphedema.

AB - Background: Vascularized lymph node transfer (VLNT) is an emerging surgical treatment for lymphedema. However, literature-comparing outcomes of upper limb lymphedema (ULL) and lower limb lymphedema (LLL) is limited. Hence, the aim of this study is to compare the long-term clinical outcomes on ULL versus LLL in patients treated with VLNT. Methods: A retrospective study retrieving data from patients with International Society of Lymphology (ISL) stages II–III who underwent different VLNTs from July 2010 to July 2016 in our institution was performed. Demographics preoperatively, and clinical data (limb circumference, infectious episodes, lymphoscintigraphic studies) preoperatively and postoperatively were recorded. Clinical outcomes by extremity were also analyzed. Results: A total of 83 patients with lymphedema (ULL: n = 30, LLL: n = 53) were included. Mean follow-up time was 32.8 months (range 24–49 months). Mean circumference reduction was higher in patients with ULL compared to with LLL (28.6 ± 8.6 vs. 22.3 ± 10.1, p <.001), and for patients with secondary lymphedema (24.8 ± 9.6, p <.001) than for patients with primary lymphedema (18.9 ± 14, p >.05). Infectious episodes per year preoperative and postoperative showed that LLL patients had higher reduction on infection rate compared with ULL patients (2.4 ± 1.1 vs. 1.9 ± 1.2, p <.001). Conclusion: VLNT is a promising surgical treatment option for patients with lymphedema. This study suggests that VLNT may have a more beneficial outcome in patients with ULL and with secondary lymphedema.

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